Findings: Fracture of the radial diaphysis at the junction of the middle and distal thirds with associated disruption of the distal radioulnar joint.
Diagnosis: Galeazzi fracture-dislocation.
N.B. This lesion is approximately three times as common as Monteggia fractures.
Treatment:
- Open reduction and internal fixation (ORIF) comprise the treatment of choice, because closed treatment is associated with a high failure rate.
- Plate and screw fixation is the treatment of choice.
- An anterior Henry approach typically provides adequate exposure of the radius fracture, with plate fixation on the flat, volar surface of the radius.
- The distal radioulnar joint injury typically results in dorsal instability; therefore, a dorsal capsulotomy may be utilized to gain access to the distal radioulnar joint if it remains dislocated after fixation of the radius. Kirschner wire fixation may be necessary to maintain reduction of the distal radioulnar joint if unstable. If the distal radioulnar joint is believed to be stable, however, postoperative plaster immobilization may suffice.
- If the distal radioulnar joint is stable: Early motion is recommended.
- If the distal radioulnar joint is unstable: Immobilize the forearm in supination for 4 to 6 weeks in a long arm splint or cast.
- Distal radioulnar joint pins, if needed, are removed at 6 to 8 weeks.
